- Trinity Health (Howell, MI)
- …an RN with demonstrated clinical expertise or equivalent experience and expertise as a Case Manager. + Certification: Case Management is desirable. + ... **Shift:** Day Shift **Description:** **POSITION PURPOSE** + The Registered Nurse Case Manager assumes overall accountability for patients' discharge plans while… more
- Trinity Health (Livonia, MI)
- …with physicians and their office staff, Patient Access, Medical Records/Health Information Management , Utilization Review / Case Management , ... to satisfy the customer's needs. Accuracy, attentiveness to detail and time management skills are required. To successfully accomplish the essential job functions of… more
- Molina Healthcare (Warren, MI)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years… more
- Corewell Health (Dearborn, MI)
- …discharge planning of all hospitalized patients. + Identifies patients that need care management services (ie utilization review ; care coordination; and/or ... case load of patients that includes facilitating utilization management , and/or care coordination during the...relevant experience Three to five years' experience in care management , utilization review , home care… more
- Corewell Health (Royal Oak, MI)
- …discharge planning of all hospitalized patients. 1. Identifies patients that need care management services (ie utilization review ; care coordination; and/or ... case load of patients that includes facilitating utilization management , and/or care coordination during the...relevant experience Three to five years' experience in care management , utilization review , home care… more
- Evolent (Lansing, MI)
- …the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent (Lansing, MI)
- …the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit ... member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical...needed for new hires to educate and train on Utilization management system and Field Medical Director… more
- Humana (Lansing, MI)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Utilization management experience in a medical management review organization, such as Medicare Advantage,... Case managers or Care managers on complex case management , including familiarity with social determinants… more
- Humana (Lansing, MI)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Utilization management experience in a medical management review organization, such as Medicare Advantage,... Case managers or Care managers on complex case management , including familiarity with social determinants… more
- Humana (Lansing, MI)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Utilization management experience in a medical management review organization, such as Medicare Advantage,... Case managers or Care managers on complex case management , including familiarity with social determinants… more